Raikin S, Cooperman D R, Thompson G H
Department of Orthopaedics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio 44106, USA.
J Bone Joint Surg Am. 1999 Jan;81(1):11-9. doi: 10.2106/00004623-199901000-00003.
Ten consecutive patients (fourteen feet) who had a painful coalition of the middle facet of the talocalcaneal joint with restricted motion of that joint were managed with a resection of the coalition and interposition of a split flexor hallucis longus tendon in 1992, 1993, or 1994. Initial nonoperative treatment of all of the feet had failed. According to the ankle-hindfoot clinical rating system of the American Orthopaedic Foot and Ankle Society, there were eleven excellent results and one good, one fair, and one poor result at a mean of fifty-one months (range, thirty-two to sixty months) after the procedure. Thirteen of the fourteen procedures resulted in considerable relief of pain, an improved range of motion of the talocalcaneal joint, and improved function of the foot. No patient had symptoms or functional impairment of the great toe secondary to the interposition of the split flexor hallucis longus tendon. On the basis of these early results, tendon interposition appears to be an excellent procedure for the treatment of a symptomatic coalition of the middle facet of the talocalcaneal joint after initial nonoperative treatment has failed. The presence of degenerative osteoarthritis in the other facets of the talocalcaneal joint is a contraindication to this procedure. The long-term results have yet to be determined. However, the standardized rating system used in the present study will allow accurate comparison of our results with those of subsequent studies.
1992年、1993年或1994年，对连续10例（14足）距下关节中关节面疼痛性联合且该关节活动受限的患者，采用联合部切除术并置入分裂的拇长屈肌腱进行治疗。所有足的初始非手术治疗均失败。根据美国矫形足踝协会的踝-后足临床评分系统，术后平均51个月（范围32至60个月）时，有11例结果为优，1例为良，1例为可，1例为差。14例手术中有13例疼痛明显缓解，距下关节活动范围改善，足部功能改善。没有患者因置入分裂的拇长屈肌腱而出现拇趾症状或功能障碍。基于这些早期结果，肌腱置入术似乎是初始非手术治疗失败后治疗距下关节中关节面有症状联合的一种极佳方法。距下关节其他关节面存在退行性骨关节炎是该手术的禁忌证。长期结果尚未确定。然而，本研究中使用 的标准化评分系统将使我们的结果能够与后续研究的结果进行准确比较。
